Effectiveness of negative pressure isolation stretcher and rooms for SARS-CoV-2 nosocomial infection control and maintenance of South Korean emergency department capacity
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SUBMITTER: Kim S
PROVIDER: S-EPMC7528735 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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Project description:Rationale & objectiveTo evaluate predictors of emergency department (ED) utilization by adult patients receiving hemodialysis (HD) and interventions to reduce ED utilization by HD patients.Study designWe searched Ovid MEDLINE, Ovid Embase, and the Cochrane Library for randomized controlled trials and observational studies published until April 2020.Setting & participantsWe included studies that investigated predictors of ED utilization and/or interventions to reduce ED utilization in HD patients. We extracted data regarding the study design and study population and results regarding ED utilization from 38 studies using Excel software.Analytical approachWe performed a narrative synthesis to group articles that investigated similar themes.Results1,060 titles and abstracts were screened, of which 98 were selected for full-text review. In total, 38 studies met the inclusion criteria and underwent data extraction. Quality was high according to the Downs and Black tool, with 11 studies rated as good, 22 as fair, and 5 as poor. 34 studies described predictors of ED utilization, whereas 4 studies investigated interventions in which ED utilization was studied. Our narrative synthesis produced 8 concept subgroups in the core concepts of access to care, comorbid condition burden, and new health care models. Poor access to care and a high comorbid condition burden are associated with increased ED use. No ED-based interventions designed to reduce ED utilization were identified, but recent changes in health care systems, like the formation of End-Stage Renal Disease Seamless Care Organizations and greater involvement of palliative care services, are associated with improved outcomes.LimitationsClinical heterogeneity and variability in the included studies precluded a meta-analysis.ConclusionsHD patients' high ED use is multifactorial. Further research is required to understand and predict ED utilization in this vulnerable population, which will facilitate the development of interventions to reduce avoidable ED use.Prospero registration numberCRD42020196569.
| S-EPMC8861946 | biostudies-literature
Project description:Around 42,000 children suffer from severe sepsis each year in the US alone, resulting in significant morbidity, mortality and billion dollar expenditures in the US healthcare system. Sepsis recognition is a clinical challenge in children. Biomarkers are needed to tailor appropriate antimicrobial therapies and improve risk stratification. The goal of this study was to determine if gene expression profiles from peripheral blood were associated with pathogen type and sepsis severity in children treated for suspected sepsis.
2020-01-01 | GSE119217 | GEO
Project description:We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician's comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient's geographical origin, while the full model evaluated the additional roles of patient's gender and language, the clinician's assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient's diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient's lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician's level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.
| S-EPMC7554163 | biostudies-literature
Project description:Emergency department (ED) crowding is a public health burden that impedes the provision of high-quality emergency care and is related to poor outcomes. Frequent ED visits are known to contribute to ED crowding. This study aimed to identify frequent ED users' characteristics and risk factors related to frequent ED visits.A retrospective observational study was conducted using ED-based data derived from adult patients at a university hospital. The main exposure variable was frequent ED visits, which were defined as ≥4 visits within 12 months (January 1-December 31, 2018). Characteristics and risk factors for frequent ED users were evaluated using stepwise regression analysis.Within the study period, there were 36,932 ED visits involving 29,759 patients. Of these, 3031 (8.2%) visits were from 556 (1.9%) patients classified as frequent ED users. The independent risk factors for frequent ED visits were older patients (≥65 years); the winter season; daytime discharge from ED; patients with medical aid insurance; and patients designated as high acuity at their first visit. Patients with a malignant neoplasm, mental health disorder, alcohol-related liver disease, chronic kidney disease, or chronic obstructive pulmonary disease were associated with more frequent ED visits.Frequent ED users comprised a significant proportion of total ED visits. Frequent ED users were more likely than occasional ED users to be in poorer health, older, or have a chronic disease or a mental health disorder.
| S-EPMC7440327 | biostudies-literature
Project description:Although nutritional problems are a major concern for the homeless, their vitamin D status has not yet been widely evaluated. This study was a retrospective chart review conducted at a single academic, urban public hospital's emergency department (ED). Patients whose serum 25-hydroxyvitamin D [25(OH)D] levels had been checked in the ED from July 2014 to June 2015 were reviewed and enrolled. For a healthy settled civilian control, 2011 and 2012 data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES) were used. A total of 179 patients were enrolled. Vitamin D deficiency was observed in 133 patients (73.7%). The vitamin D deficiency group showed a lower hemoglobin level than that of non-vitamin D deficiency group (p = 0.02). Winter visits were more common among the deficiency group (p = 0.048). Rhabdomyolysis was observed only in the deficiency homeless group (p = 0.03). When using age and sex as covariates of propensity score matching 25(OH)D levels were lower in the homeless than in the healthy control (15.7 ± 7.4 ng/mL vs. 18.2 ± 5.5 ng/mL, p < 0.001). Moreover, when the controls were limited to residents of the same city, the serum 25(OH)D level also was lower in the homeless than in the control (15.7 ± 7.4 ng/mL vs. 17.1 ± 5.4 ng/mL, p = 0.03). In summary, vitamin D deficiency was common and more frequent among homeless patients.
| S-EPMC6521275 | biostudies-literature
Project description:Norovirus (NoV) is an important cause of nosocomial gastroenteric outbreaks. This 5-month study was designed to characterize NoV contamination and airborne dispersal in patient rooms during hospital outbreaks. Air vents, overbed tables, washbasins, dust, and virus traps designed to collect charged particles from the air were swabbed to investigate the possibility of NoV contamination in patient rooms during outbreaks in seven wards and in an outbreak-free ward. Symptomatic inpatients were also sampled. Nucleic acid extracts of the samples were examined for NoV RNA using genogroup I (GI) and GII real-time reverse transcription-PCR (RT-PCR). The NoV strains were characterized by RT-PCR, sequencing, and phylogenetic analysis of the RNA-dependent RNA-polymerase-N/S capsid-coding region (1,040 nucleotides [nt]). Patient strains from two outbreaks in one ward were sequenced across the RNA-dependent-RNA-polymerase major capsid-coding region (2.5 kb), including the hypervariable P2 domain. In the outbreak wards, NoV GII was detected in 48 of 101 (47%) environmental swabs and 63 of 108 patients (58%); NoV genotype II.4 was sequenced from 18 environmental samples, dust (n = 8), virus traps (n = 4), surfaces (n = 6), and 56 patients. In contrast, NoV GII was detected in 2 (GII.4) of 28 (7%) environmental samples and in 2 (GII.6 and GII.4) of 17 patients in the outbreak-free ward. Sequence analyses revealed a high degree of similarity (>99.5%, 1,040 nt) between NoV GII.4 environmental and patient strains from a given ward at a given time. The strains clustered on 11 subbranches of the phylogenetic tree, with strong correlations to time and place. The high nucleotide similarity between the NoV GII.4 strains from patients and their hospital room environment provided molecular evidence of GII.4 dispersal in the air and dust; therefore, interventional cleaning studies are justified.
| S-EPMC4097690 | biostudies-literature
Project description:Objectives: Using the Andersen's Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ? 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29-0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04-2.31), individuals with two CMCs or less (OR = 2.61 (1.03-6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36-5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25-0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01-2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13-5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
| S-EPMC6479964 | biostudies-literature
Project description:ObjectivesEmergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding.MethodsThis was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures.ResultsThe mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005).ConclusionsAn increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does not appear to be an adequate solution to ED crowding.
| S-EPMC4046120 | biostudies-literature
Project description:Anaphylaxis can cause death and requires immediate management. For prevention and education programs for anaphylaxis, it is important to be aware of the common triggering factors. We investigated the triggers of anaphylaxis in the emergency departments (EDs) of community hospitals in Korea.Patients who visited the EDs of 7 community hospitals for anaphylaxis from January 1, 2012 to December 31, 2016 were enrolled. Anaphylaxis was defined according to the World Allergy Organization criteria and identified via a thorough review of the medical records of patients who were diagnosed with anaphylaxis (ICD-10 codes: T780, T782, T805, and T886) at the ED or administered epinephrine in the ED. Triggers of anaphylaxis were also evaluated by a review of the medical records.We identified 1021 ED visits for anaphylaxis. The incidence of anaphylaxis ED visits was 0.08%. The triggers of ED visits for anaphylaxis were bee venom (55.0%), foods (21.3%), and drugs (13.2%); 9.6% of cases were idiopathic. However, food was the most common trigger among the patients aged <20 years old. The frequency of ED visits for anaphylaxis was highest in summer (47.9%), followed by autumn (28.2%), spring (12.3%), and winter (11.6%). The incidence of anaphylaxis ED visits was highest in August, during which bee venom was the trigger for 80% of anaphylaxis cases. For the 55 patients with repeat ED visits for anaphylaxis, Bee venom was also the most common trigger.The number of ED visits for anaphylaxis showed marked seasonal variation, peaking in summer. Bee venom was the most common trigger for adults and the main reason for seasonal variations of anaphylaxis ED visits in Korean community hospitals.
| S-EPMC6358383 | biostudies-literature
Project description:The COVID-19 pandemic and discovery of new mutant strains have a devastating impact worldwide. Patients with severe COVID-19 require various equipment, such as ventilators, infusion pumps, and patient monitors, and a dedicated medical team to operate and monitor the equipment in isolated intensive care units (ICUs). Medical staff must wear personal protective equipment to reduce the risk of infection. This study proposes a tele-monitoring system for isolation ICUs to assist in the monitoring of COVID-19 patients. The tele-monitoring system consists of three parts: medical-device panel image processing, transmission, and tele-monitoring. This system can monitor the ventilator screen with obstacles, receive and store data, and provide real-time monitoring and data analysis. The proposed tele-monitoring system is compared with previous studies, and the image combination algorithm for reconstruction is evaluated using structural similarity index (SSIM) and peak signal-to-noise ratio (PSNR). The system achieves an SSIM score of 0.948 in the left side and a PSNR of 23.414 dB in the right side with no obstacles. It also reduces blind spots, with an SSIM score of 0.901 and a PSNR score of 18.13 dB. The proposed tele-monitoring system is compatible with both wired and wireless communication, making it accessible in various situations. It uses camera and performs live data monitoring, and the two monitoring systems complement each other. The system also includes a comprehensive database and an analysis tool, allowing medical staff to collect and analyze data on ventilator use, providing them a quick, at-a-glance view of the patient's condition. With the implementation of this system, patient outcomes may be improved and the burden on medical professionals may be reduced during the COVID-19 pandemic-like situations.
| S-EPMC10502084 | biostudies-literature